Update on New Year's Resolutions

Way back in January, I wrote a New Year's Resolution post about my one very small, seemingly easy resolution:  to stay out of the hospital.  Sadly, Monday I'll have to break that promise.

I managed to get through this last bout of anxiety and hypomania without having to go back into the hospital (it was touch-and-go, especially at the end of this week), but I have to go into the hospital Monday to get a lovely hernia taken care of.  Most hernia repairs are laproscopic and out-patient, but I get big hernias that take a team of people to fix (I don't really know that, but I know it's big and complicated) and will be in the hospital for at least a night, possibly up to three.

So send me good vibes and let's hope this is the last time I hear the word "hernia" in relation to me like, ever (I had another a couple of years ago which sucked).  When I'm back vertical I'll let you know how it went.

But You Look So Good!

A while ago, I sat in a room listening to one woman tell another that even though she was depressed, she looked so beautiful and professional and "together."

I know this woman was trying to make the other feel better; I mean, who doesn't want to hear they're beautiful?  But having been on the receiving end of the same kinds of compliments (not recently -- recently I look like I've been beaten by the ugly stick), I know that when you feel ugly and crappy on the inside, usually the last thing you want to hear is that you look good on the outside.  I don't speak for everyone; I know there are people that this kind of compliment would make them feel better, and more power to them.  But for me, this kind of compliment is not helpful.

I think there's something about someone saying, "But you look so good!" when you're depressed that can minimize your internal suffering, at least in my experience.  It's like the complimenter (is that a word?) is saying, "But you look so good -- you can't feel that bad!"  Unfortunately, you can look beautiful and feel like complete shit on the inside.  Look at all the celebrities with eating disorders, drug and alcohol problems, and horrible relationship trouble.  Of course they look beautiful.  That's what they do.  But they probably don't feel beautiful.

I had a doctor's appointment this morning, my fourth in three weeks.  I actually considered putting on mascara this morning, and then a little voice told me not to, because, while I've been feeling somewhat better, I still don't feel great -- and I didn't want her to see mascara and think, "Oh, she must be better."  I would think I could expect more from a doctor, but you never know.

It's just another example of how we can't judge a book by its cover.  I think a lot of people still have the mental picture of depression and mental illness as a disturbed person on the streetcorner raving about academic fraud (a nod to my UD friends) or the end of the world, a person you cross the street to avoid.  That woman in the three-inch-heeled boots at Starbucks, the woman pushing her baby in an expensive, pristine stroller, the woman in the office next to you that always has her hair done so nicely, they may all be suffering from various forms of depression or mental illness.  Just because they "look good" doesn't mean they feel good.  It also doesn't mean they don't rant about the end of the world, but that's a different issue.

The Unending Chain of Side Effects

I saw my psychiatrist today, as I have the last three Wednesdays.  Let me first say, that despite the fact I have to drive over an hour down and back for my twenty minute appointment, I really do like my doctor.  She seems really on top of things, and also seems to be interested in continually expanding her knowledge.  To a teacher, that's pretty much the best personality trait anyone can have.
The reason I'm seeing her so frequently is that I'm trying to change meds.  I was on a ton of Seroquel plus lithium, and we're trying to phase out the Seroquel and get me on another atypical antipsychotic.  Last week, she cut my Seroquel almost in half and prescribed Abilify, something I was on a long time ago but don't remember a lot about.

Turns out, the Abilify (like Geodon before it, another atypical antipsychotic) gives me akathasia.  Akathasia, in lay terms, is when you get really antsy and jittery and feel like you can't sit still.  It was worse on the Geodon, but it seems to be getting steadily more irritating the longer I'm on Abilify.  So to combat the akathasia, my doctor prescribed a drug called Propranalol that works by lowering your blood pressure and making you less antsy.

To make a long story shorter, it ends up I can't take the Propranalol because it gave me chest pains, made me a little shaky, and I have a level 1 AV block (a very minor heart condition) that isn't a big deal by itself, but could be an issue on the medication.  So now we have to change directions and move towards Depakote rather than Abilify.

The problem with Depakote?  It causes weight gain, which is one of the reasons I was trying to get off Seroquel in the first place.  So now I have to go to my primary care doctor and see about taking a drug for diabetes 2 called Metformin, which helps with weight loss. 

I talked a few days ago about the idea of getting off of meds completely; this whole side effect debacle makes me even more interested in the idea of getting off drugs.  I feel like we're getting to the point where we're managing side effects more than we're managing the underlying problems, my bipolar disorder.

Does anyone with chronic problems have this same issue?  The daunting task of managing side effects?  Of taking drugs to offest the drugs you're taking?  It's frustrating, and if I didn't have anxiety problems already, I'd definitely have them now. 

Home Again, Home Again, Jiggity Jig

That's right, I'm out of the clink -- er, hospital -- and back home.  I just took a really long, hot shower and thoroughly enjoyed not having to hit the little button every two minutes for the water to stay on.

I have not forgotten my give-away; there's just a little snafu.  Nobody wrote in the comments when you liked BPK on Facebook!  My Facebook "Likes" went up, but since I'm technologically stupid at the moment, I can't figure out who actually hit "Like" in the last week or so.  So I'll figure something else out...maybe give it based on who has commented in the last week?  That may work.

In addition to leaving the hospital today, I actually had my first of six scheduled ECT (Electroconvulsive Therapy) treatments this morning.  Let me tell you, it was trippy.  I will write more about that soon, but I have to be truthful -- even I feel like ECT is a sort of taboo topic.  In the meantime, I'll figure out this giveaway issue.  If you really think you'd like to read the book (again, it's Start Something that Matters by Blake Mycoskie, the TOMS guy -- it is pretty inspiring), send me an email or leave a comment and maybe I'll just send it to the first person who asks!

Oh, and p.s. -- my dad is out of the hospital and is doing well.  Obviously, I decided not to go if, instead, I went to the hospital myself for the week, but he's out of the woods and is going to be fine.  I hope to plan a trip to Florida in the not-to-distant future.

Great Expectations, Deflated

Here I am, still in Shawshank. No, no, I kid.

Mostly.

Today I'm mostly upset with the fact that I was supposed to go home, as per my doctor. But the weekend psychiatrist on duty never got around to seeing me and finalizing my paperwork today, even though I have been bugging the nursing staff about it since 9 this morning.

I thought I'd think positively and have my husband and daughters come down around 3, and maybe by the time they got here I'd be ready to go. No such dice. Looks like I'll probably be here till Monday, with my contraband iPod to keep me company.

The most frustrating part is that I actually feel pretty okay; I don't feel the need to be put away for safety reasons. And the staff here does next to nothing on weekends, as far as group therapy and entertainment go, so it's not like I'm getting lots of benefit there.

So, in a nutshell, I feel safe enough to leave, am bored out of my mind, and had to peel a shrieking five-year-old off my leg when she left.

Oh, holy hell...someone just started playing "Kumbaya" on an acoustic guitar and singing. I think I should have kept my mouth about the entertainment. Is 6:30 too early to go to bed?

Check Me Out -- I'm Home, and Away From the Horrors....

of 24-hour-a-day Christmas music.

That's right.  I had to go stay in a "mental health facility" (but I usually think of it as a "looney bin," even though I know that's totally un-PC), and just in case us patients didn't feel shitty enough, the place was pumping Christmas music through the stereo in all the common areas 24/7.  And it wasn't even Thanksgiving, for God's sake! 

Plus, it was bad Christmas music -- I heard Mariah Carey more than once.  Thankfully I didn't hear that damn hippopotamus song, because I probably would have ended up restrained, or taken to the "tub room" (I actually don't know what the "tub room" is, but there was a door by my room marked as such and I've seen enough bad movies and House reruns to conjure up images of a big basin floating with ice cubes they dunk you in to calm you down).

As a result of the holiday cheer onslaught, I've put a moratorium on Christmas music at my house for at least another week, unless it's instrumental/ambient or classical (like, no lyrics classical -- not Bing Crosby classical) Christmas music.  Frankly, as I get older, I like that kind of Christmas music better anyway.

I'm not trying to make light of my stay at the Lindner Center (which is really the absolute opposite of a "looney bin" -- it's beautiful, bright, and modern with a very caring staff and doctors, Christmas music aside).  But I actually have so much I want to say about my stay there, what I learned, what medications I'm now on -- and how I got to be in such a crisis state that I had to go stay there -- that I'm still trying to organize it all in my mind.  

I will say that I almost kissed the psychiatrist, though, when she informed my husband that no amount of exercise, "good eating," or other coping mechanisms would have helped me get out of the funk that brought me there. I had to stop myself from jumping up, doing a little dance, and screaming, "I F*CKING TOLD YOU SO!"

But I'm classy, and very magnanimous, so I didn't.

I hope everyone had a wonderful holiday!

Oh, Oh, Where'd You Go, Psychiatrist?

[Warning:  self-reflective diatribe ahead]

In looking back over previous posts, it occurs to me that way too many of my titles are in the form of a question.  Maybe I watch too much Jeopardy!, but I think the larger reason is that a lot of my posts are, indeed, questions.  When I teach Freshmen Composition, we learn that one way to "enter a conversation" about a specific topic is to raise questions about what has already been said in that conversation. For example, if you wanted to write a research paper on inane children's TV programs, you could say, "Experts believe that The Fresh Beat Band helps children learn about music and friendship.  But who are these experts?  And why isn't anyone beating them with a sock full of pennies?"

He he he -- guess someone else hates Twist too!

(Sorry, I hate The Fresh Beat Band.)

Anyhow, that's how I sort of view this blog:  an attempt to enter the conversation about mental health care and mental illness (and knitting) through question-raising and providing jumping off points for new conversations.  Of course, that's very ambitious, and I know that it takes a lot more than one loser posting random rants about Nick Jr. TV shows, but I'm trying.

[/warning]

ANYHOW, on to the real topic of this post.  I got a letter in the mail this week informing me that my psychiatrist -- the one it took me months to find and get an appointment with this past winter -- is leaving private practice to work at a local University.

Well, shit.

Good for her and all, but what the hell do I do now?  This winter, when I needed a doctor, I honestly asked anyone that would listen who I should go to for psychiatric care, and nobody (read:  NOBODY) had any good suggestions.  I've been through several therapists and psychiatrists already, and have heard various negative things about more doctors in the area. Let me say, pickings are slim.  For heaven's sake, my OB-GYN's office was calling me to recommend a psychiatrist for a patient a month ago.  That should speak volumes about the number of doctors in the area.

I went through a lot of blood, sweat, and tears to try to find a doctor this past winter, and now it seems I have to start the whole process over again.  Not only am I unhappy about it, I'm a little overwhelmed.  And pissed.  I know there is no benefit to being angry and upset, but I can't help it.  I'll get myself together and try to start making calls in the next day or two, but right now, I'm just going to let myself wallow in the injustice of it all.

Okay, that's a little dramatic -- how about if I just let myself rant?  Damn you, doctor!  Damn you, mental health care system!  Damn you, Dayton, Ohio!

I feel a little better now.  On with the show.

World Mental Health Day: Where's My Ribbon?

Happy World Mental Health Day! 

Yep, today is World Mental Health Day, designed to "raise public awareness about mental health issues" (per the World Health Organization).  Incidentally, it is also Columbus Day and World Homeless Day.  And, unless you live under a rock, October is Breast Cancer Awareness Month, designed to raise awareness (and raise funds, and sell pink crap) for breast cancer.

I'm not saying these other issues aren't important -- well, maybe I am saying that Columbus Day isn't that important, except to people who get off work and school because of it -- because, let's face it, cancer and homelessness are both major concerns in our society today.  In fact, if most people had to prioritize, I'm sure that cancer would be number one, homelessness number two, and mental health number three.  And I understand that.  But let's look at statistics.

According to the American Cancer Society (cancer.org), almost 570,000 people died of cancer in America in 2010, and a little over 40,000 of those deaths were from breast cancer.  Incidentally, lung cancer comprised 157,000 of those deaths, and I don't see a month dedicated to that.  You can see all the statistics here. 

Turning to look at the stats on mental health, this interesting article from the founder of PsychCentral.com, Dr. John Grohol estimates that around 33,000 people die each year in the world of untreated mental illness.  That statistic may be low, too, because there's little information from third-world countries about mental illness mortality.

Though it's hard to find hard statistics on homelessness and mortality, it isn't hard to find statistics on the link between homelessness and mental illness.  According to the National Coalition for the Homeless, as many as 25% of homeless people are mentally ill -- compared to 6% of the general population.

Lastly, in a big "well, duh" statistic, this snippet from the National Alliance on Mental Health reports that experts estimate upwards of 50% of cancer patients suffer from depression, anxiety, and other serious mental health issues.

That's a lot of statistics, and it's obvious that cancer kills a lot more people a year than mental illness does.  But we also have consistent, pervasive awareness of cancer, and a buttload of funds going to cancer (well, at least some types of cancer), every year.  And if someone learned they had cancer, I can guarantee that it wouldn't take them three months to get in to see a doctor, and they wouldn't have family members telling them that it's all "in their head."

Out of curiosity, I did a google search for "October 11, 2011" and nothing about World Mental Health Day came up.  A lot of stuff came up about Judgement Day (should that be capitalized?) and the end of the world, which I'll have to read about later.  But as far as awareness goes, I think the US has a long road ahead.  Mental illness isn't sexy.  Nobody has a "Bipolar Disorder 5k Fun Run."  Very few people, if any, have a "Mental Illness Awareness" ribbon stuck to their car -- let alone their water bottles, wrist bands, or Swiffer Sweeper refills.  In fact,  I'm not even sure there is a mental health awareness ribbon; a google image search for "Mental Illness Awareness Ribbon" comes up with multiple colored ribbons -- some blue, some green, and hey, even a pink one comes up. 

Just because there are no ribbons, no fun fund-raising events, and no pervasive marketing for it, mental illness is still a very real problem in this country and world-wide.  I guess we don't need a ribbon to understand that fact.

Will another mental health facility help?

Last week, I wrote a post about the lack of mental health care both in Dayton, Ohio, and in general.  An article from the Dayton Daily News today discussed the grand opening of a new psychiatric hospital in the area, which sounds like a step in the right direction.

Or is it?

Access Hospital Dayton is a for-profit facility, opening where a state hospital (Twin Valley Behavioral Health Center, or TVBH) used to be, until it closed in 2008.  It is run by a private company, owned by two psychiatrists.  It will have 28 beds initially, and the director hopes to expand to over 100 when it's all said and done.  I can't find a website for it (which doesn't mean it doesn't exist, but it's not obvious), and all the information I'm getting is coming from the DDN and from the Dayton Business Journal.

The facility will not take anyone on Medicare or Medicaid; it will only take patients with private insurance that will cover the costs, or patients who are willing to pay for the care themselves. It sounds like, from the Dayton Business Journal article, the owner plans to expand to accept Medicare and Medicaid, but that's a future plan.

[Side note:  In my opinion, 28 beds sounds pretty paltry, so I tried to do a comparison.  I looked up the Linder Center of Hope, a facility down in Mason, Ohio, that I visited (ha, sounds so pleasant) this spring.  It has 48 acute inpatient rooms for adolescents through adults, and has capacity for 16 people to stay long-term in their Sibcy House.  They also have various outpatient programs.  And they take Medicare and Medicaid.]

Maybe this is good news for Dayton.  We need mental health care, and that's 28 beds that Dayton didn't have before, right?  Well, at least since 2008, when the TVBH closed down.

And that's where things get a little more grim.  TWBH was a state hospital, and had an over 100 bed capacity.  They were a state hospital, so they took Medicare and Medicaid.

What's also significant is that over half of their patients at the time of their closure were forensic patients -- that is, people who were in some phase of the criminal justice system.  Now, those patients will either be transferred for care out of the area -- if care can be found -- or shuffled back through the criminal justice system.  Or, worse yet, released without treatment back into society, sure to end up back in front of a judge at some point.  (Statistics come from an articled called "Reopening of Mental Hospital Won't Help Uninsured Patients" from the Dayton Daily News -- may not be available when you click on it).

According to the National Alliance on Mental Health, "64 percent of local jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms of serious mental illnesses" (From "Department of Justice Study:  Mental Illness of Prison Inmates Worse than Past Estimates").  

It's been proven, then, that there is a high percentage of mentally ill inmates, and it's no secret that Dayton's crime rate is pretty bad.  From neighborhoodscout.com:

• Dayton's "Crime Index," with 100 being the safest, is 5 -- this means that Dayton is safer than 5% of the cities in the country
• An individual's chance of being a victim of violent crime in Dayton is 1 in 98; in Ohio it is 1 in 287
• The murder rate per 1000 people is .21; the national average is .05
• Note:  all these stats are from neighborhoodscout.com:  click here to see how they got them) 

Is there a correlation here?  I have to think there is.

So, hip hip hooray that a new mental health facility is opening in town.  Obviously, Dayton (and the country in general) needs all the help it can get.  But, contrary to their name ("Access Hospital"), this facility won't serve the segments of the population most in need.

I guess we still have a ways to go in mental health care for the area, and the country.

Why can't we find mental health help??

A couple of weeks ago, the nurse from my OB-GYN's office called and left a message, asking me to call her because she had a question "not related" to me, but more of a general nature.

It turns out that there was a patient in the office who was in desperate need of psychiatric care and was having a problem getting an appointment to see any doctors or therapists.  The nurse wanted to know what psychiatrist I saw, if I liked her, and if it was easy to get an appointment in her office.


Now, I have a good relationship with everyone in my OB's office, mainly because when I was pregnant this past year I called them on average, oh, a million times a week.  Sadly, at one point, the nurses knew my phone number when it came up on caller ID and knew to answer if it was me.  They were aware of my mental health problems and my struggle to find help, so I'm not shocked they called me to see if I could recommend someone for their patient.

That being said, how sad is it that the doctor's office was calling me?  I'd like to think I'm something of an expert -- on pretty much everything, really -- but the reality is I'm just a girl (cue Gwen Stefani) who has had mental health problems.  What does it say about the state of our mental health care system when someone is calling me for guidance?  It's terrifying, frankly.

Doing a little research on psychiatric care in this country reveals some really scary statistics.  A 2006 study in North Carolina, conducted in part by Duke University, showed that there was 1 psychiatrist for every 10,000 people in the state.  It also found that many patients' insurance was lacking when it came to mental health care, which made it harder for them to find help.  (Source:  "Report Finds Limited Number of Psychiatrists Statewide")

A blog called "Health and Medical News and Resources" states that there is a shortage of 45,000 psychiatrists in the United States.  If I was teaching, I don't know if I'd let a student use this blog as a credible source, but I did find the statistic repeated on a page on medscape.com.  Apparently it comes from a study with...a lot of impressive looking references.  The medscape.com page also has an interesting interview with several psychiatrists about the state of the mental health system in the country.

Unfortunately, the lack of care isn't just frustrating -- it has serious ramifications.  For example, in the same interview, one of the psychiatrists state that studies show 16% of prisoners have some form of mental illness (you may have to have a medscape.com account to see this page).  These are people who, if given proper mental health care, would likely not be in prison, but in a psychiatric facility or treated to the point they can live productive lives.

I could go on and on -- I haven't even mentioned the epidemic of mental illness among the homeless -- but I'll leave it at that for now.  I also would be interested in looking up statistics on Ohio in particular, but I'll do that in another post. 

In summation, the statistics are staggering. 

It's actually pretty depressing. 

I think I'll go knit.

The shoe never fits

I had a therapy appointment today, the first one in a long time.  I didn't feel like I really needed it, but the reminder call came too late for me to cancel the appointment (there's a $75 fee for cancelling less than 24 hours in advance).  So I went, and just bailed early by saying I had someplace else to be.

My therapist is a nice guy, but he spent 15 of our 30 minutes together talking about his vacation and his vacation home.  If he was just a friend, fine, but I'm spending like $90 to meet with him, so time is money.  I have decided I'm not going to go back to see him.

The problem is, he's the...let's count...fifth therapist I've seen and dumped.  To be fair, one stopped practicing, but that was after I stopped seeing her regularly.  I really have never found a therapist who I "clicked" with.  Is it me?  A doctor once suggested I had Borderline Personality Disorder, based on my serial doctor-relationship issues.  Maybe she was right.  I just know I've never found a good fit.

Now, much like a perpetual spinster (does anyone actually use that word anymore?), I'm starting to wonder if there really is a therapist out there that's right for me.  Maybe I'll never find my match.  Maybe I'll fumble through life without the all-important therapist-patient relationship, destined to walk the earth with unexplored psychoses.  And, much like the perpetual spinster, I'm ready to give up on therapy altogether, writing it off as a romanticized ideal that never lives up to its promises.

Or maybe all therapy is a bunch of crap, and I'm just coming to this conclusion now. 

Off topic:  I did a Google image search for "pencil and paper," and this terrifying picture came up (it really is terrifying, so if you don't want to see it, don't click).  What the HELL?

The "Pregnant" in" Pregnant Bipolar Knitter"

I haven't talked too much about the "pregnant" in my blog title, mainly because other than the rampant depression/psychological problems I've had, the pregnancy has been healthy and uneventful.

Today, though, it's hard to ignore. I've been in the "PicU" (which I think stands for perinatal intensive care unit) since yesterday. My due date isn't until April 17, but I started getting pretty regular contractions last week. I've been having Braxton-Hicks contractions for about two months, but these were different. I came down to Labor & Delivery on Friday night, and they ran a few tests and checked me for dilation; despite the fact that I was 1 cm dilated (admittedly, not much) and 50% effaced, the doc on call opted not to do the fetal fibronectin test which can give an idea if you are going to go into labor soon or at least not for the next two weeks.

(Note that the doc on call was the doc that delivered my first daughter...which is a whole other story, but I told the nurse that I would drive home and have my baby there rather than have him ever touch me again. But I digress.)

Anyway, yesterday the contractions started getting stronger and more painful. My ob told me to come down to get checked, and lo and behold I was now 2 cm dilated AND the fetal fibronectin test was positive. So my doctor admitted me and started me on a course of muscle relaxers to halt the contractions and steroids to help the baby's development. They'd like to delay at least a few weeks. Seems like things are going according to plan, as the contractions are getting better. Hopefully I get to go home tomorrow.

That's my current story. I will say that the maternity ward is far preferrable to the psych ward; they don't care if I have ballpoint pens or drawstrings, AND I have internet access. Life is good (well, other than the fact I'm in the hospital).

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